The uninterpreted rage: Protecting the therapeutic alliance in the treatment of borderline patients

After reviewing differing approaches to the treatment of the borderline patient, this paper describes the treatment of a patient whose negative transferences are not interpreted by the therapist; rather, the focus is on maintaining the therapeutic alliance via the awareness of the kinship selfobject function of the therapist and merger with the idealized selfobject.There is no end unless the bottom of the trough has been reached, unless the thing feared has been experienced. (Winnicott in Casement, 1991, pp. 129–130). As a matter of fact in these cases it is of decisive importance for the psychotherapist to remain clearly differentiated from the core of psychopathology—if he cannot achieve this separation and becomes drawn into the patient's delusions, he loses his tie to the healthy remainder of the patient's psyche and thus his therapeutic leverage. The maintenance of a realistic, friendly relationship with the psychotherapist is thus of crucial importance in the treatment of the psychoses and borderline states ... (Kohut, 1971, p. 30).